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Updated: June 11, 2025
Further, the problem of awakening enthusiasm and desire is the therapeutic problem of the physician and especially in the condition described as anhedonia.
He was examined, nothing wrong was found and he was sent back to duty. From that episode dates as typical an anhedonia as I have ever seen. Gradually he became sleepless and woke each day more tired than he went to bed. The food displeased him, and he grumbled over what were formerly trifles. He wearied easily, and nothing seemed to move him to enthusiasm or desire.
In anhedonia, as first described by Ribot, mentioned by James, and which has recently been worked up by myself as a group of symptoms in mental and nervous disease, as well as in life in general, there is a characteristic lack of enthusiasm in anticipation and realization, a lack of appetite and desire, a lack of satisfaction. Nothing appeals, and the values drop out of existence.
Nevertheless there are people who will resist these fundamental desires, as in the case of MacSwiney, the Irish republican, and as in the case of martyrs recorded in the history of all peoples. It may be that in some of these we are dealing with a powerful inhibition of appetite of the kind seen in anhedonia.
Let there be a sudden blocking of a purpose or an aim, so that it seems impossible of fulfillment, and energy-feeling drops; movement, thought, even feeling seem painful. The will flags, and the whole world becomes unreal. This is part of the anhedonia we spoke of. In reality, we have the disappearance of hope as basic in this adynamia.
After an illness, particularly influenza, when recovery has seemingly taken place, there develops a lack of energy feeling and the whole syndrome of anhedonia which lasts until the subtle damage done by the disease passes off. Half or more of the "nervousness" in the world is based on actual physical trouble, and the rest relates to temperament.
The victims of anhedonia at first pass from one "pleasure" to another, hoping each will please and satisfy, but it does not. Food, drink, work, play, sex, music, art, all have lost their savor. Restless, introspective, with a feeling of unreality gripping at his heart, the patient finds himself confronting a world that has lost meaning because it has lost enthusiasm in desire and satisfaction.
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